gms | German Medical Science

Objectives/Interrogation: We present our experience with 7 spasticity patients.

We present where we were succesful, where we failed and what we have to recommend in the management of this challenging and increasing population

Methods: We have operated on 7 spasticity patients from 2015 to date. Causes of spasticity were CVA (thromboembolic or haemorrhagic)and traumatic brain injury.

Patients were evaluated preoperatively using the Ashworth and House scale. Video evaluations were used as well and two of the patients received Botollinum Toxin injections.

The aim of surgery was primarily to reduce spasticity and if possible, improve the functional outcome as well.

Post-operatively, the patients were referred for physiotherapy and occupational therapy to obtain the best possible outcome (Table 1 [Tab. 1]).

Results and Conclusions: All seven patients had a reduction of spasticity. Two patients had an improved functional outcome which allowed them to use their hands again for basic functions.

Thromboembolic CVA patients despite having reduced spasticity, did not have any functional gains.

One of the patients unmasked intrinsic spasticity after the procedure.

Patients with traumatic brain injuries and haemorrhagic CVAs (and no other concomittant injuries) were more prone to developing spasticity of the intrinsics (3 in our series) than patients that suffered a thromboembolic CVA.

In conclusion, patients with spasticity need to be evaluated meticulously and for a significant amount of time prior to surgical intervention.

We believe that there is a link between haemorhagic brain injuries (of traumatic aetiology or CVA) and intrinsic spasticity but further research needs to be done to solidify this argument.

Tendon transfers to augment finger extension have no place in spasticity surgery.

Neurectomies tend to produce very good results regarding the elimination of spasticity.

Patients need to be informed that spasticity surgery is about reducing spasticity and not about improving the functional outcome, although there are cases that they some functional improvement could be expected (especially in patients following traumatic brain injury).